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922 N. Washington Avenue, Ludington, MI 49431 Phone: 800-261-4919 Fax: 866-892-2478 www.theradapt.com email@example.com IMPORTANT INFORMATION REGARDING THIRD PARTY BILLING TherAdapt® Products Inc. sells to customers around the world and across the United States. We are able to help you facilitate payment from a third party payer such as your Private Medical Insurance Carrier or Medicaid, but we are not able to bill these parties directly. Procurement of third party funding for medically necessary durable medical equipment can usually be obtained by following the procedures outlined below. Private Medical Insurance Step 1: Prior to contacting your insurance company, have the following information at hand: Primary insurance company name: Policy number: Group number: Policy holder’s name: Insured’s name: Date of birth: Step 2: Verify the following information with the insurance company customer service representative: Customer service phone number: Contact person: Billing / Claims address: Customer service fax number: Case manager’s name: No case manager: Case manager phone: Fax: Step 3: Ask the following questions: Does have coverage for Durable Medical Equipment?: YES Is there a contract with a preferred provider?: YES Who is the preferred provider?: Phone number of preferred provider: Contact: Is there a Deductible?: YES What is the amount?: _$ What is the coverage benefit amount / percentage?: Is Pre-certification / authorization required?: YES What steps do I need to take?: Is there a separate claim status phone number?: If there is a secondary insurance company or co-insurance follow the above procedure for that company as well. Step 4: Do the following: Obtain a “Letter of medical Necessity” from your Physical Therapist, Occupational Therapist, Physician, or other appropriate allied healthcare professional. Examples of these letters for the products of our manufacture, that are generally considered medically necessary, can be found at www.theradapt.com. Have your Physician provide a written “Prescription” that defines or itemizes the exact adaptive equipment that is being recommended. If there is NOT a preferred provider contact us at 800-261-4919 or firstname.lastname@example.org for a written “Quote” that lists the model number, description, and price of the recommended items. Note: if you are working with a preferred provider they will obtain this information. If there is NOT a preferred provider, file the necessary claims forms and / or submit the information to the insurance company (companies) for prior approval. If you are working with a preferred Durable Medical Equipment Provider follow their procedure. Many parents and caregivers will do one of the following once the pre-approval process is completed: Purchase the product(s) from TherAdapt® Products Inc. using a personal check or credit card (Visa, MasterCard, American Express, or Discover). Orders are processed and shipped immediately. Reimbursement is made to you from the insurance company. Wait to receive a check from the insurance company, then purchase the equipment from TherAdapt® Products Inc. using a personal check or credit card (Visa, MasterCard, American Express, or Discover). Order will be shipped once payment in full is received. Request the insurance company endorse the check to: TherAdapt® Products Inc. 922 N. Washington Ave. Ludington, MI 49431 Your order will be shipped once payment in full is received. Medicaid The acquisition of medically necessary durable medical equipment, that is to be funded by Medicaid, must be provided through a Medicaid approved Durable Medical Equipment Supplier in your state. To assist in this process it is helpful to do the following: Obtain a “Letter of medical Necessity” from your Physical Therapist, Occupational Therapist, Physician, or other appropriate allied healthcare professional. Examples of these letters for the products of our manufacture, that are generally considered medically necessary, can be found, along with specific product information, at www.theradapt.com. Have your Physician provide a written “Prescription” that defines or itemizes the exact adaptive equipment that is being recommended. If you need assistance in finding a Durable Medical Equipment (DME) supplier in your area please select the “Dealer Info” button on our website, call us at 800-261-4919, or e-mail us at email@example.com. We recommend you keep a log of who you spoke with and when as you follow up on the status of your claim. Date Contact Summary Thank you for choosing TherAdapt® Products Inc. If you have any questions or need further assistance, please feel free to contact us 24 hours a day at firstname.lastname@example.org or call us at 800-261-4919 to reach a customer service representative. Our office hours are Monday – Friday 9:00am – 5:00pm, EST. We are here to help!
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